Project Summary/Abstract New Hampshire has second the highest per capita rate of opioid use disorders (OUD) and the highest rate of fentanyl overdose in the U.S. An estimated 10% of deliveries are affected by perinatal OUD, and New Hampshire can anticipate as many as 1,000 infants born with prenatal opioid exposure each year. Roughly 40% of recent opioid overdose deaths in NH were women, and 21% of pregnancy-associated deaths between 2013-2015 were attributed to overdose. The American College of Obstetricians and Gynecologists, American Academy of Pediatrics, and American Society for Addiction Medicine call for adoption of care models that promote early identification and treatment for pregnant and parenting women with OUD. Medication-assisted treatment (MAT) is the recommended best practice for pregnant women with OUD. Even when MAT is initiated, rates of treatment discontinuation and relapse are high, particularly in the early postpartum period. Barriers to retention include high rates of depression, anxiety, and posttraumatic stress disorder, and adverse social conditions (e.g., housing and economic insecurity, interpersonal relationship violence). Pain management is also complicated for pregnant women with OUD, and under-management of pain is a strong risk factor for relapse. Contemplative, such as yoga and mindfulness, may reduce risks for relapse for pregnant and parenting women with OUD. Building capacity for providing MAT and collaborative care to pregnant and parenting women with OUD in obstetric settings is a priority of the New Hampshire State Targeted Response (STR) to the Opioid Crisis. This project represents a partnership with NH stakeholders to augment this STR initiative through development and pilot evaluation of a trauma-informed yoga and mindfulness relapse prevention intervention (Mindful Moms in Recovery: MMORE). The R21 phase has three specific aims: 1) Identify needs and areas of adaptation of trauma-informed yoga and mindfulness-based relapse prevention protocols through formative work with pregnant and parenting woman, 2) Develop an integrated10-session intervention protocol with iterative feedback from client stakeholders, and 3) Evaluate feasibility, acceptability and efficacy trends of MMORE in a pre-post pilot with pregnant women. Demonstrated milestones will provide the foundation for the R33, with three specific aims: 1) Evaluate MMORE in a small randomized controlled study with pregnant women as an augment to collaborative MAT care in obstetric practices for impact on MAT treatment retention, relapse, and risk indicators (depression, anxiety, stress, pain management), 2) Examine mechanisms of treatment effects on outcomes assessed longitudinally into postpartum, 3) Evaluate barriers and facilitators to translation and sustainable implementation of MMORE for women receiving MAT as part of obstetric care. If successful, MMORE will offer a non-pharmacological alternative to support recovery and improve the lives of pregnant and parenting women with OUD and their infant children.